Discipline Decisions (Winter 2019)

• Failed to appoint a Designated Manager for Remedy’s Rx Brock Medical Pharmacy for the periods between January 9, 2017-April 19, 2017 and/or June 12, 2017-August 11, 2017;
• Failed to pay costs of $1,000.00 each for monitoring inspections conducted by the College at Bathurst-Dundas Guardian Pharmacy on or about April 21, 2017 and/or at Remedy’s Rx Brock Medical Pharmacy on or about April 27, 2017 pursuant to the terms, conditions or limitations imposed on her certificate of registration by order of a Panel of the Discipline Committee on December 8, 2016 (Decision and Reasons issued in writing on April 7, 2017);
• Failed to pay costs to the College by installments of $1,250.00 each on January 8, 2017; April 8, 2017; July 8, 2017; and/or October 8, 2017 as ordered by a Panel of the Discipline Committee on December 8, 2016 (Decision and Reasons issued in writing on April 7, 2017)

In particular, the Panel found that she:

• Contravened a term, condition or limitation imposed on her certificate of registration
• Contravened section 146(1.1) of the Drug and Pharmacies Regulation Act, R.S.O. 1990, c. H-4, as amended
• Failed to comply with an order of a Committee or a panel of a Committee of the College
• Engaged in conduct or performed an act relevant to the practice of pharmacy that, having regard to all the circumstances, would reasonably be regarded by members as dishonourable and unprofessional

The Panel imposed an Order which included as follows:

1. A reprimand

2. Directing the Registrar to impose specified terms, conditions, or limitations on the Member’s Certificate of Registration requiring that:

(a) the Member shall pay to the College, by certified cheque or bank draft, the total amount of $5,750.00, allocated as follows:

(i) $3,750.00 on account of unpaid and outstanding costs owed to the College by the Member as a result of the Order of the College Discipline Committee, dated December 8, 2016; and
(ii) $2,000.00 on account of unpaid and outstanding costs owed to the College by the Member as a result of College monitoring inspections conducted on April 21, 2017 and April 27, 2017.

(b) the $5,750.00 payment described in subparagraph 2(a) shall be payable in installments of $500.00, with the first installment due immediately following the hearing on November 21, 2018, the second installment due on April 1, 2019, and each subsequent installment due on the first day of each month thereafter, until the full amount has been paid by the Member to the College.

3. Directing the Registrar to suspend the Member’s Certificate of Registration for a period of not less than two (2) months, to commence on December 1, 2018 and continue without interruption until January 31, 2019, and then to continue until the $5,750.00 payment described in subparagraph 2(a) has been paid in full. The suspension of the Member’s Certificate of Registration shall itself be suspended on February 1, 2019 and shall remain suspended as long as the Member complies with the schedule of payment by installments set out in subparagraph 2(b) above. If the Member fails to pay any installment payment due to the College in accordance with the payment schedule described in subparagraph 2(b), the suspension of the Member’s Certificate of Registration shall be reinstated forthwith and the suspension of the Member’s certificate of registration shall continue unless and until the Member makes all payments due to the College to the date of such payment, at which time the suspension of the Member’s Certificate of Registration shall be suspended again.

4. Costs to the College in the amount of $1,250.00.

In its reprimand, the Panel noted that the Member, with her actions, has tainted the entire profession in the eyes of the public. Her actions have also completely disregarded the governing authority of the College.

The Panel pointed out that the practice of Pharmacy is a privilege that carries with it significant obligations to the public, the profession and to oneself. The Member’s misconduct has eroded the public trust in the pharmacy profession and cast a shadow over her own integrity.

The Panel expressed its hope that this hearing has given the Member the opportunity to pause for reflection and move forward in practising pharmacy within the standards of the profession, and that she will not appear again in front of a panel of the Discipline committee.

• Failed to complete the remedial training as required by subparagraph 3(i) of the Order of the Discipline Committee Panel of the Ontario College of Pharmacists dated September 24, 2015 (the “Order”) within the time required by the Order, and failed to successfully complete that remedial training within the additional time provided by the Registrar to do so, at his request;
• Failed to access and read encrypted email communications sent to him by the College regarding the Order on October 26, 2015;
• Failed to respond to the College’s inquiries to him regarding the Order and the remedial training required by subparagraph 3(i) of the Order, sent to him by letters and/or e-mails dated October 26, 2015, April 27, 2016, October 3, 2016 and October 24, 2016; and/or
• Failed to respond to the College’s investigation regarding his failure to complete the remedial training required by subparagraph 3(i) of the Order, despite having been granted several extensions of the time to provide a response.

In particular, the Panel found that he

• Contravened a term, condition or limitation imposed on his certificate of registration
• Failed to maintain a standard of practice of the profession
• Engaged in conduct or performed an act or acts relevant to the practice of pharmacy that, having regard to all the circumstances, would reasonably be regarded by members of the profession as disgraceful, dishonourable and unprofessional

At the same hearing, the Panel also made findings of professional misconduct against Mr. Kothari, while engaged in the practice of pharmacy as director, shareholder, Designated Manager and/or dispensing pharmacist at Ace Pharmacy at 6-1 Bartley Bull Parkway in Brampton, Ontario (“Ace Bartley”) and Ace Pharmacy at 11-6980 Maritz Drive in Mississauga, Ontario (“Ace Maritz”), in that he:

• Submitted and/or permitted, consented to or approved, either expressly or by implication, the submission of, accounts or charges for services that he knew were false or misleading to the Ontario Drug Benefit program through Ace Maritz for:
  • one or more of certain identified drugs and/or products, from on or about February 22, 2013 to on or about January 22, 2015,
  • one or more of certain identified drugs and/or products, transferred from Ace Bartley to Ace Maritz between on or about February 22, 2013 and on or about January 22, 2015; and/or
  • one or more of certain identified MedsCheck reviews, submitted from on or about May 1, 2013 to on or about December 25, 2013, which were non-compliant with the guidelines of the Ministry of Health and Long Term Care;
• Falsified and/or permitted, consented to or approved, either expressly or by implication, the falsification of pharmacy records relating to his practice in relation to the dispensing of and/or claims made to the Ontario Drug Benefit program through Ace Maritz for:
  • one or more of certain identified drugs and/or products, from on or about February 22, 2013 to on or about January 22, 2015,
  • one or more of certain identified drugs and/or products transferred from Ace Bartley to Ace Maritz between on or about February 22, 2013 and on or about January 22, 2015; and/or
  • one or more of certain identified MedsCheck reviews submitted from on or about May 1, 2013 to on or about December 25, 2013, which were non-compliant with the guidelines of the Ministry of Health and Long Term Care; and/or
• Failed to ensure that Ace Maritz and/or Ace Bartley complied with all legal requirements, including but not limited to, requirements regarding the transfer of prescriptions, record keeping, documentation, and billing the Ontario Drug Benefit Plan

In particular, it is alleged that he

• Failed to maintain a standard of practice of the profession
• Failed to keep records as required respecting his patients
• Falsified and/or permitted, consented to or approved, either expressly or by implication, the falsification of records relating to his practice
• Signed or issued, in his professional capacity, and/or permitted, consented to or approved, either expressly or by implication, the signing or issuing of a document that he knew contained a false or misleading statement
• Submitted and/or permitted, consented to or approved the submission of accounts or charges for services that he knew to be false or misleading
• Contravened the Pharmacy Act,1991, the Drug and Pharmacies Regulation Act, the Regulated Health Professions Act, 1991 or the regulations under those Acts and in particular:
  • Sections 155 and 156 of the Drug and Pharmacies Regulation Act, R.S.O. 1990, c. H-4, as amended
• Contravened a federal or provincial law or municipal by-law with respect to the distribution, sale or dispensing of any drug or mixture of drugs, and in particular:
  • Sections 5, 6 and 15(1)(b) of the Ontario Drug Benefits Act, R.S.O. 1990, c. O.10, as amended, and/or Ontario Regulation 201/96 made thereunder
  • Sections 155 and 156 of the Drug and Pharmacies Regulation Act, R.S.O. 1990, c. H-4, as amended
  • Section 43(2)(b) of Ontario Regulation 58/11 under the Drug and Pharmacies Regulation Act, R.S.O. 1990, c. H-4, as amended
  • Sections 8, 10 and 11 of the Narcotics Safety and Awareness Act, 2010 SO 2010, c 22
• Permitted, consented to or approved, either expressly or by implication, the contravention of a federal or provincial law or municipal by-law with respect to the distribution, sale or dispensing of any drug or mixture of drugs
  • Sections 5, 6 and 15(1)(b) of the Ontario Drug Benefits Act, R.S.O. 1990, c. O.10, as amended, and/or Ontario Regulation 201/96 made thereunder
  • Sections 155 and 156 of the Drug and Pharmacies Regulation Act, R.S.O. 1990, c. H-4, as amended
  • Section 43(2)(b) of Ontario Regulation 58/11 under the Drug and Pharmacies Regulation Act, R.S.O. 1990, c. H-4, as amended
  • Sections 8, 10 and 11 of the Narcotics Safety and Awareness Act, 2010 SO 2010, c 22
• Engaged in conduct or performed an act or acts relevant to the practice of pharmacy that, having regard to all the circumstances, would reasonably be regarded by members of the profession as disgraceful, dishonourable and unprofessional

Following findings of professional misconduct made on November 12 2018, and a further day of submissions on December 11, 2018, the Panel imposed an Order which included as follows:

1. A reprimand
2. Directing the Registrar to revoke the Member’s Certificate of Registration
3. Costs to the College in the amount of $66,478.79,

The reprimand in this matter remains outstanding.

• Submitted and/or permitted, consented to or approved, either expressly or by implication, the submission of, accounts or charges for services that she knew or reasonably ought to have known were false or misleading to the Ontario Drug Benefit program for:
  • one or more of certain identified drugs and/or products, from on or about January 1, 2009 to on or about May 31, 2010, and/or
  • 679 MedsCheck reviews submitted from on or about January 23, 2008 to on or about June 30, 2010 which were non-compliant with the guidelines of the Ministry of Health and Long Term Care
• Falsified and/or permitted, consented to or approved, either expressly or by implication, the falsification of, pharmacy records in relation to claims made to the Ontario Drug Benefit program by a corporation of which she a director and/or shareholder for:
  • one or more of certain identified drugs and/or products, from on or about January 1, 2009 to on or about May 31, 2010, and/or
  • 679 MedsCheck reviews submitted from on or about January 23, 2008 to on or about June 30, 2010 which were non-compliant with the guidelines of the Ministry of Health and Long Term Care
• Failed to ensure that the Pharmacy complied with all legal requirements, including but not limited to, requirements regarding record keeping, documentation, and billing the Ontario Drug Benefit Plan.

In particular, the Panel found that she

• Failed to maintain a standard of practice of the profession
• Falsified and/or permitted, consented to or approved, either expressly or by implication, the falsification of, records relating to her practice
• In her professional capacity, signed or issued and/or permitted, consented to or approved, either expressly or by implication, the signing or issuing of a document that she knew contained a false or misleading statement
• Submitted and/or permitted, consented to or approved the submission of accounts or charges for services that she knew to be false or misleading
• Contravened the Act, the Drug and Pharmacies Regulation Act, the Regulated Health Professions Act, 1991 or the regulations under those Acts , and in particular:
  • Sections 5, 6 and 15(1)(b) of the Ontario Drug Benefits Act, R.S.O. 1990, c. O.10, as amended, and/or Ontario Regulation 201/96 made thereunder and/or sections 156, 163 and 166 of the Drug and Pharmacies Regulation Act, R.S.O. 1990 , c. H.4, as amended
• Contravened a federal or provincial law or municipal by-law with respect to the distribution, sale or dispensing of any drug or mixture of drugs, and in particular:
  • Sections 5, 6 and 15(1)(b) of the Ontario Drug Benefit Act, R.S.O. 1990, c. O.10, as amended, and/or Ontario Regulation 201/96 made thereunder and/or sections 156, 163 and 166 of the Drug and Pharmacies Regulation Act, R.S.O. 1990, c. H.4, as amended
• Permitted, consented to or approved, either expressly or by implication, the contravention of a federal or provincial law or municipal by-law with respect to the distribution, sale or dispensing of any drug or mixture of drugs, and in particular:
  • Sections 5, 6 and 15(1)(b) of the Ontario Drug Benefit Act, R.S.O. 1990, c. O.10, as amended, and/or Ontario Regulation 201/96 made thereunder and/or sections 156, 163 and 166 of the Drug and Pharmacies Regulation Act, R.S.O. 1990, c. H.4, as amended
• Engaged in conduct or performed an act or acts relevant to the practice of pharmacy that, having regard to all the circumstances, would reasonably be regarded by members of the profession as disgraceful, dishonourable and unprofessional

Following findings of professional misconduct made on August 23, 2018, and a further day of submissions on December 17, 2018, the Panel imposed an Order which included as follows:

4. A reprimand;
5. Directing the Registrar to revoke the Member’s Certificate of Registration; and
6. Costs to the College in the amount of $46,858.98.

The reprimand in this matter remains outstanding.

• Keeping medication on the dispensary shelf that was not properly labelled;
• Keeping medication in the dispensary that had previously been dispensed to patients and returned;
• Failing to dispose of expired products in a reasonably expeditious manner;
• Failing to document transfers of medications between pharmacies.

In particular, the Panel found that she

• Failed to maintain a standard of practice of the profession
• Failed to provide an appropriate level of supervision to a person she was professionally obligated to supervise
• Returned to stock, re-sold or re-dispensed a drug that was previously sold or dispensed
• Engaged in conduct or performed an act relevant to the practice of pharmacy that, having regard to all the circumstances, would reasonably be regarded by members of the profession as unprofessional

The Panel imposed an Order which included as follows:

1. A reprimand

2. That the Registrar is directed to impose specified terms, conditions or limitations on the Member’s Certificate of Registration, and in particular:

a. that the Member successfully complete, at her own expense, within 12 months of this Order:

i. the ProBE course on Professional, Problem-Based Ethics; and
ii. the College’s Jurisprudence Exam.

b. that for a two-year period commencing December 18, 2018, the Member shall be prohibited from acting as a Designated Manager in any pharmacy.

c. that the Member’s practice will be monitored by the College for a period of two years from the date of this Order on the following terms:

i. the monitoring will be by means of up to three inspections conducted by a representative of the College at such times as the College may determine;
ii. the monitoring inspections may be in addition to any routine inspections conducted by the College pursuant to the Drug and Pharmacies Regulation Act, R.S.O. 1990, c. H.4., s. 148;
iii. the Member shall cooperate fully during such inspections; and,
iv. the Member shall pay to the College in respect of such monitoring inspections the amount of $1,000.00 per inspection, after each inspection

3. That the Registrar is directed to suspend the Member’s Certificate of Registration for a period of four months, with one month of the suspension to be remitted on condition that the Member complete the remedial training as specified in paragraph 2(a).

4. Costs to the College in the amount of $5,000.00.

In its reprimand, the Panel noted that the Member failed to maintain the responsibilities and obligations expected of her as a member of this profession.

The Panel related that pharmacy is a self-regulated profession, and that pharmacists bear the responsibility to ensure that they maintain the trust of the public and members. The practice of pharmacy is a privilege and it comes with significant obligations to the public, the profession and oneself.

The Panel expressed its expectation that, in the future, the Member will practice pharmacy within the standards of this profession, and that she will take this opportunity to reflect on her actions and complete the required remediation. In doing so, the Panel expects that the Member will change the way she practices and that she will not appear again in front of a panel of the discipline committee.

• On or about June 16, 2014, he inappropriately touched […];
• He failed to provide to the Registrar the details of a charge against him under the Criminal Code of Canada, as set out in an information sworn on or about August 11, 2014, namely a charge relating to the offence of sexual assault;
• He failed to provide to the Registrar the details of a finding of guilt made against him on or about May 19, 2016,* namely a finding that he committed the offence of sexual assault, within 30 days of that finding, as required by the By-Laws of the Ontario College of Pharmacists; and
• On or about April 3, 2018, he was found guilty of sexual assault, contrary to section 271 of the Criminal Code of Canada.

* Note: this conviction was set aside following an appeal, and a new trial was ordered.

In particular, the Panel found that he

• Has been found guilty of an offence that is relevant to his suitability to practise
• Contravened a term, condition or limitation imposed on his certificate of registration
• Failed to maintain the standards of the profession
• Engaged in conduct relevant to the practice of pharmacy that, having regard to all of the circumstances, would reasonably be regarded by members of the profession as disgraceful, dishonourable and unprofessional

The Panel imposed an Order which included as follows:

1. A reprimand
2. Directing the Registrar to revoke Mr. Maharem’s Certificate of Registration
3. Costs to the College in the amount of $12,000

In its reprimand, the Panel noted that Mr. Maharem has been convicted of an appalling breach of the standards of practice of the profession of pharmacy. The Panel observed that members of the public hold pharmacists in high regard. As a pharmacist, Mr. Maharem failed in his moral obligation to conduct himself in a manner that was professional and maintains public confidence.

The Panel pointed out that pharmacy is a self-regulated profession, and that it has a responsibility to ensure that the public is adequately protected and to maintain the public’s confidence in its ability to govern members.

The Panel noted that pharmacists are expected to demonstrate personal and professional integrity and to maintain professional boundaries at all times. These boundaries are based on trust, respect and the appropriate use of power. Mr. Maharem’s conduct undermined the foundation of the trust that exists between pharmacy professionals, employees, and the public.

The Panel observed that it has an obligation to ensure that the penalty is appropriate to the findings. The Panel expressed its view that Mr. Maharem’s actions constitute one of the most serious manifestations of professional misconduct and therefore the legislated mandatory revocation is warranted.